An Alternative View of Self-Discharge Against Medical Advice: An Opportunity to Demonstrate Empathy, Empowerment, and Care

Machin, Laura; Goodwin, Dawn; Warriner, David

doi:10.1177/1049732318754514

Cited by 19 publications

(31 citation statements)

References 24 publications

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“…Although self-discharge can be associated with adverse health outcomes [ 7 ], competent patients have an inalienable right to make this decision. The decision to self-discharge removes the shackles associated with the ‘patient’ label and enables recovery of a person’s individual identity.…”

Section: Discussionmentioning

confidence: 99%

“…People who self-discharge are generally perceived as poor decision makers and castigated, either to their face or in their medical records, for behaving inappropriately [ 7 ]. The very language used is adversarial and denotes a hierarchy where health professionals’ decisions and opinions take precedence over those of their patients, rendering patients relatively powerless.…”

Section: Introductionmentioning

confidence: 99%

“…The very language used is adversarial and denotes a hierarchy where health professionals’ decisions and opinions take precedence over those of their patients, rendering patients relatively powerless. If a patient does decide to self-discharge, their reasoning is questioned, and they are typically derided as irrational and labelled as demanding [ 7 ]. However, competent patients in Australia and elsewhere have the legal right to make decisions about their healthcare, including the right to self-discharge from a healthcare facility [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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“I’m outta here!”: a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital

Askew

Foley

Kirk

et al. 2021

BMC Health Serv Res

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Background Occasions of self-discharge from health services before being seen by a health profession or against medical advice are often used by health systems as an indicator of quality care. People self-discharge because of factors such as dissatisfaction with care, poor communication, long waiting times, and feeling better in addition to external factors such as family and employment responsibilities. These factors, plus a lack of cultural safety, and interpersonal and institutional racism contribute to the disproportionately higher rates of Indigenous people self-discharging from hospital. This qualitative study aimed to increase understanding about the causative and contextual factors that culminate in people self-discharging and identify opportunities to improve the hospital experience for all. Methods Semi-structured interviews with five Aboriginal and/or Torres Strait Islander (hereafter, respectfully, Indigenous) people and six non-Indigenous people who had self-discharged from a major tertiary hospital in Brisbane, Australia, were audio-recorded, transcribed and thematically analysed. Results Study participants all respected hospitals’ vital role of caring for the sick, but the cumulative impact of unmet needs created a tipping point whereby they concluded that remaining in hospital would compromise their health and wellbeing. Five key categories of unmet needs were identified – the need for information; confidence in the quality of care; respectful treatment; basic comforts; and peace of mind. Although Indigenous and non-Indigenous participants had similar unmet needs, for the former, the deleterious impact of unmet needs was compounded by racist and discriminatory behaviours they experienced while in hospital. Conclusions Respectful, empathetic, person-centred care is likely to result in patients’ needs being met, improve the hospital experience and reduce the risk of people self-discharging. For Indigenous people, the ongoing legacy of white colonisation is embodied in everyday lived experiences of interpersonal and institutional racism. Racist and discriminatory behaviours experienced whilst hospitalised are thus rendered both more visible and more traumatic, and exacerbate the deleterious effect of unmet needs. Decreasing self-discharge events requires a shift of thinking away from perceiving this as the behaviour of a deviant individual, but rather as a quality improvement opportunity to ensure that all patients are cared for in a respectful and person-centred manner.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

“I’m outta here!”: a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital

Askew

Foley

Kirk

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…The patient's "face" may also set boundaries over the entity of the patient versus that of the physician, avoiding the use of excess power. Following Levinas, who calls to direct excess power toward empowerment, rather than dictating a path, physicians may frame patients' refusal of treatment as patient centeredness (Machin, Goodwin, & Warriner, 2018).…”

Section: Responsibility To Another's Self-worth In Faceto-face Encounmentioning

confidence: 99%

Patient Self-worth and Communication Barriers to Trust of Israeli Patients in Acute-Care Physicians at Public General Hospitals

Gabay

2019

Qual Health Res

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Patient trust is positively related to health outcomes, but there remain barriers to patient trust in physicians. This narrative study analyzed patient experiences and highlights barriers to patient trust underlying communication with physicians in acute care. Snowball sampling was used. Informants were 12 participants, in poor physical health, upon discharge from a 3-week hospitalization in an acute-care setting at an Israeli public general hospital. Two narrative interviews were conducted with each participant upon and after discharge. Findings suggest presurgery barriers to trust (lack of acknowledgment of patient’s crisis, underrating patient’s autonomy, and use of unique empathy) and postsurgery barriers to trust (lack of attentive listening, lack of medical professionalism, and delegitimization to patients’ self-alienation). Two common narrative identities emerged linking trust with self-worth. To build trust, physicians are called upon to extend their dedication from dedication to improve clinical outcomes to dedication to improve clinical outcomes and preserve patients’ self-worth.

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“…Discharge against medical advice (DAMA) is when a patient chooses to leave the hospital before a physician advises discharge [1]. In addition, it is considered an escape (absence without leave, absconding, or elopement) when the patient leaves the hospital without notification from an involuntary unit or walks out of a voluntary unit.…”

Section: Introductionmentioning

confidence: 99%

Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department

et al. 2021

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Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

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An Alternative View of Self-Discharge Against Medical Advice: An Opportunity to Demonstrate Empathy, Empowerment, and Care

Cited by 19 publications

References 24 publications

“I’m outta here!”: a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital

“I’m outta here!”: a qualitative investigation into why Aboriginal and non-Aboriginal people self-discharge from hospital

Patient Self-worth and Communication Barriers to Trust of Israeli Patients in Acute-Care Physicians at Public General Hospitals

Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department

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